Selfies help

Quick Summary

Patients often arrive after rashes have faded, but smartphone photos taken over days or weeks can document flare-ups for evaluation.
The author describes a case where a young woman’s current redness was mild, but an earlier selfie showed a much more severe reaction.
The photo helped diagnose granulomatous rosacea, a more serious form that involves heavy mite infestation and potential scarring.
Treatment discussed includes ivermectin, including a newer topical option and the author’s past use of a single oral dose with success.
The post encourages patients to photograph skin changes and bring the images to their dermatologist.

As physicians, we hear it time and time again – “By the time I came in to see you, my rash disappeared!” Well, no longer. More and more patients come into our clinic, showing us photos of their skin ailment on their mobile devices taken over a few days or even weeks at a time. This activity is extremely helpful in making a more precise diagnosis.

A recent example of how your photos can assist us is in the case of a young woman from Montreal, Quebec, Canada. She had a few little red marks here and there, but nothing compared to the way the area looked in the selfie she showed me from a week prior.

Due largely to her photo, we were able to determine she had a more serious form of Rosacea – Granulomatous Rosacea, which requires us to treat the mites heavily infecting the skin (possibly causing scarring). Thankfully, there’s a new topical agent that helps with this condition called Ivermectin. I have used one oral dose of Ivermectin over the years very successfully to treat this type of Rosacea.

Kudos to all of you who take photographs of yourselves and bring them to your dermatologist!

Happy Holidays!

Dr. Levy

FAQ - Frequently Asked Questions

Why do dermatologists find photos of a rash or flare-up so helpful?

Many skin conditions come and go, so the skin may look normal by the time you’re seen. Photos capture the timing, color, distribution, and progression, which can narrow the diagnosis. They also help your dermatologist compare today’s exam with what you experienced at its worst.

How should I take good photos of my skin problem for my appointment?

Take photos in natural light (near a window) and avoid heavy filters or flash if it changes the color. Include one close-up and one wider shot to show location on the body, and add a common object (like a coin) for scale. If it changes over time, take a quick series: day 1, day 3, day 7, and during any flare.

What is granulomatous rosacea, and how is it different from typical rosacea?

Granulomatous rosacea is a less common form that can present as firm red-brown bumps or plaques, sometimes with less obvious flushing than classic rosacea. It can mimic other conditions, which is why documenting earlier, more inflamed stages can be valuable. Your dermatologist may consider additional evaluation to confirm the diagnosis and rule out look-alikes.

When should I book an urgent visit instead of waiting and just taking photos?

Seek prompt care if you have rapid swelling, blistering, skin pain out of proportion to the rash, fever, facial/eye involvement, or trouble breathing. Also book sooner if the rash is spreading quickly, oozing, or you’re immunocompromised. Photos are helpful, but they shouldn’t replace timely evaluation when symptoms are severe or escalating.

If my dermatologist suspects rosacea mites, what treatments might be discussed and what affects cost?

Treatment may include topical options such as ivermectin, sometimes combined with other anti-inflammatory or antibiotic therapies depending on severity. Costs depend on whether a brand vs. generic is used, your insurance coverage, and how long treatment is needed; many prescriptions fall roughly in the $30–$300/month range without coverage. Your dermatologist can tailor a plan that balances effectiveness, tolerance, and affordability.